DURVALUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
|---|---|---|---|---|---|---|---|---|---|
| 11911XMP | DURVALUMAB Injection (PI, CMI)
|
1500 mg | 4 | $11049.88 | $31.60 | $31.60 |
DURVALUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
|---|---|---|---|---|---|---|---|---|---|
| 11915DMP | DURVALUMAB Injection (PI, CMI)
|
1500 mg | 4 | $10853.55 | $31.60 | $31.60 |
DURVALUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
|---|---|---|---|---|---|---|---|---|---|
| 13745KMP | DURVALUMAB Injection (PI, CMI)
|
1500 mg | 5 | $11049.88 | $31.60 | $31.60 |
DURVALUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
|---|---|---|---|---|---|---|---|---|---|
| 13766MMP | DURVALUMAB Injection (PI, CMI)
|
1500 mg | 5 | $11049.88 | $31.60 | $31.60 |
DURVALUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
|---|---|---|---|---|---|---|---|---|---|
| 13767NMP | DURVALUMAB Injection (PI, CMI)
|
1500 mg | 5 | $10853.55 | $31.60 | $31.60 |
DURVALUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
|---|---|---|---|---|---|---|---|---|---|
| 13775BMP | DURVALUMAB Injection (PI, CMI)
|
1500 mg | 3 | $10853.55 | $31.60 | $31.60 |
DURVALUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
|---|---|---|---|---|---|---|---|---|---|
| 13779FMP | DURVALUMAB Injection (PI, CMI)
|
1500 mg | 3 | $11049.88 | $31.60 | $31.60 |
DURVALUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
|---|---|---|---|---|---|---|---|---|---|
| 13780GMP | DURVALUMAB Injection (PI, CMI)
|
1500 mg | 5 | $10853.55 | $31.60 | $31.60 |
DURVALUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
|---|---|---|---|---|---|---|---|---|---|
| 14889PMP | DURVALUMAB Injection (PI, CMI)
|
1500 mg | 5 | $11049.88 | $31.60 | $31.60 |
DURVALUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
|---|---|---|---|---|---|---|---|---|---|
| 14925MMP | DURVALUMAB Injection (PI, CMI)
|
1500 mg | 5 | $10853.55 | $31.60 | $31.60 |
DURVALUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
|---|---|---|---|---|---|---|---|---|---|
| 14932XMP | DURVALUMAB Injection (PI, CMI)
|
1120 mg | 5 | $8285.26 | $31.60 | $31.60 |
DURVALUMAB
|
|
|
|
| Code & Prescriber | Name, manner of administration | Max amount | No. of repeats | DPMA | Max Safety Net | General Patient Charge | |||
|---|---|---|---|---|---|---|---|---|---|
| 14942KMP | DURVALUMAB Injection (PI, CMI)
|
1120 mg | 5 | $8127.10 | $31.60 | $31.60 |
- Legend
- MPMedical Practitioner




